St John'S Recovery Place LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

ST JOHN'S RECOVERY PLACE LLC

Practice address

1125 N Summit St
Crescent City, FL 32112-1721

Phone

(954) 945-2984

NPI assigned

Jun 4, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shimon Buhadana

Title

Ceo/Owner

Phone

(954) 658-7148

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528070400000",
    "number": "1215429436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 N SUMMIT ST",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "321121721",
            "telephone_number": "954-945-2984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 N SUMMIT ST",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "321121721",
            "telephone_number": "954-945-2984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN'S RECOVERY PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-04",
        "last_updated": "2018-06-04",
        "status": "A",
        "authorized_official_last_name": "BUHADANA",
        "authorized_official_first_name": "SHIMON",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "954-658-7148"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Crescent City, FL
• Providers in Crescent City, FL by specialty
• Substance Abuse Rehabilitation Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.